MEDICARE: CITY OF KELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	220032	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558384552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF KELLER

Provider Business Mailing Address
First Line	:	PO BOX 770
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76244-0258
Country	:	US
Telephone Number	:	817-743-4400
Fax Number	:	817-743-4409

Provider Business Practice Location Address
First Line	:	1100 BEAR CREEK PKWY
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2114
Country	:	US
Telephone Number	:	817-743-4400
Fax Number	:	817-743-4409

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	CHARLIE SKAGGS
Credential	:
Telephone Number	:	817-743-4460

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/06/2026

Similar Medicare Providers

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Practice Location Address:

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1003447384 — ALLIANCE ORTHOTICS AND PROSTHETICS, L.L.C.
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1740283134 — DR. GREGORY DALE GARLETT D.C.
Practice Location Address:

1200 KELLER PKWY , STE 300
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1356347306 — DR. GREGORY MICHAEL FULLER M.D.
Practice Location Address:

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1730186230 — DR. NIRAJ MAHENDRA MEHTA D.O.
Practice Location Address:

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1518967041 — DR. COLLEEN MARIE RYAN MD
Practice Location Address:

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Practice Fax: --

Directions to “CITY OF KELLER ” Practice Location

Language	Start Address	Practice Location

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